Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Corporate Action Center Hotline - (02)441-7442
MDR
www.philhealth.gov.ph

MEMBER DATA RECORD

MEMBER INFORMATION
Philhealth Identification Number (PIN) : 090502350330
Member Category : INFORMAL ECONOMY NHTS Coverage :
Sub-Category : MIGRANT WORKER Effectivity Period :

FERRANCULLO , BRYAN SOLIS

TABOBO-AN, ODIONGAN, ROMBLON 5505

Foreign Address : N/A Sex : Male

Date of Birth : 12/04/1988
Place of Birth : ODIONGAN, ROMBLON

Contact No.(Foreign) : N/A Civil Status : SINGLE

(Local) : Tax Identification Number :

EMPLOYER/ORGANIZED GROUP INFORMATION

PhilHealth Number (PEN/POGN) : N/A
Name of Employer/Organized Group : N/A
Business Address : N/A

Telephone Number : N/A

Tax Identification Number : N/A

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
*** NO DECLARED DEPENDENT/S ***

PAYMENT INFORMATION
Coverage OR Number Amount Date of Payment
8/8/2014 to 8/7/2015 10934018L 2400.00 8/8/2014

Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, dalhin agad ang kopya sa pinakamalapit na PhilHealth Office upang maiwasto. Ingatan ang inyong
kopya ng MDR at huwag ibigay kahit kanino.
Reminder: Read the contents of the MDR. Should there be discrepancies, bring your copy to the nearest PhilHealth Office to amend or rectify error. Take good care
of the MDR and do not hand it over to anybody.

This is a Member Inquiry System generated report.

12/7/2017 8:35:21 PM